CAJ | 학술논문

目的探讨提高大鼠原位肝移植（rat orthotopic liver transplantation, ROLT）成功率的相关技术细节及围手术期处理的正确方法。方法以Kamada建立的“双袖套”法为基础，通过反复练习，逐步改进麻醉、肝上下腔静脉吻合、供肝灌洗、供肝冷保存、术后补液、动物饲养等方法。结果完成ROLT达270余例，建模的学习曲线非常陡峭，分作探索期、突破期、成熟期，手术成功率分别为0%、71.1%、94.5%，后期达到90%以上的成功率。肝上下腔静脉的吻合是大鼠原位肝移植建模过程中最为关键的步骤和难点。结论通过对显微外科技术细节的精益求精的训练及细致的围手术期处理，才能提高ROLT手术成功率和术后存活时间。
목적탐토제고대서원위간이식（rat orthotopic liver transplantation, ROLT）성공솔적상관기술세절급위수술기처리적정학방법。방법이Kamada건립적“쌍수투”법위기출，통과반복연습，축보개진마취、간상하강정맥문합、공간관세、공간랭보존、술후보액、동물사양등방법。결과완성ROLT체270여례，건모적학습곡선비상두초，분작탐색기、돌파기、성숙기，수술성공솔분별위0%、71.1%、94.5%，후기체도90%이상적성공솔。간상하강정맥적문합시대서원위간이식건모과정중최위관건적보취화난점。결론통과대현미외과기술세절적정익구정적훈련급세치적위수술기처리，재능제고ROLT수술성공솔화술후존활시간。
Objective To investigate the surgical techniques and appropriate perioperative management for ensuring successful orthotopic liver transplantation (ROLT) in rats. Methods Based on the double-cuff technique of Kamada, we modified the surgical techniques of separation, perfusion and cold preservation of the donor liver, shearing and anastomosis of the suprahepatic vena cava with optimized postoperative infusion protocols and animal care. Results Two hundred and senventy rats underwent ROLT and a learning curve of the success rate was built to reflect the impovment of techniques. The learning curve showed steep improvemts over the exploration stage, breakthrough stage and maturation stage, and the success rates incresed sharply over time (0%, 71.1%, and 94.5%, respectively) until finnally reaching over 90%. The shearing and anastomosis of the suprahepatic vena cava remained the most critical and difficult techniques in ROLT modeling. Conclusion Proficient microsurgical techniques and meticulous nursing can reduce postoperative complications, enhance operational success rate and extend the survival time after ROLT.